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 Emergency Room Triage

Triage is the clinical process of sorting patients based on their medical urgency to maximize survival rates and use limited resources efficiently.

Sorting through the spectrum of illnesses and injuries is a tough job. Day after day, night after night there can be sick children, injured athletes, serious auto and motorcycle accidents, heart attacks, strokes, bleeding wounds, life threatening allergic reactions and so on. 

On the other hand there are people using the emergency room as their family doctor, drama queen hypochondriacs, drug seekers, the mentally ill homeless and so on. 

The stress level is high but patience is low. People are in pain, anxious, fearful but mostly bored. Our average trip to the emergency room tests and all has been five or so hours. This small hospital is the only trauma center in central Oregon. Helicopter Life Flights fly directly over our house day and night and usually get front of the line treatment, but if you are a walk in and are stable you can be waiting longer.

The usual first come first serve rules do not apply in an emergency room. This seems to be beyond some peoples' sense of reason and fairness. A sprained wrist vs a heart attack, seasonal flu vs a severed hand is different than a place in line at the bank or grocery store check out. Some people understand and just grin and bear it but some get angry and complain. 

The chaos becomes second nature to the staff, but at times their patience wears thin. Being bored with the usual cuts sprains and fevers one minute and a minute later they may face an overwhelming life threatening event or a DOA. They probably never see a normal shift if there is such a thing so over time it takes a toll. If in the midst of the chaos they ask an impatient question or give a short and maybe rude  response I understand.

Over the years I've spent many hours in the Bend Emergency Room  a with patient and as a patient. I find a busy ER is an excellent people watching spot. The drug seekers are the most fun to watch because as soon as a nurse or doctor passes by they flop faster then a professional soccer player. The cringed look on their face and posture of chronic pain is entertaining. 

Entitled Kens and Karens march to the desk each time they take a patient that arrived after them sighting unfairness and giving their best suffering face, if you have children you know that face.

The couple being held by the police are arguing at alcohol volume as they wait for stitches. The worried mother holding her new born baby while her hyperactive son bounces around the waiting room with a broken arm waiting for stitches, an x-ray and a cast. 

Every patient face tells a story, even the nurses, doctors and aids as they rush by, some ignore and some smile. 

I believe an emergency room is in an alternate universe or dimension. All sense of time is distorted one side never having enough time while the other is experiencing a complete time stand still. 

I've been on both ends of the spectrum, the dehydrated stubborn athlete who never drinks enough water to the guy with a severed artery with his arm wrapped in a towel. Each time when I was  called I got the "Why are they taking you before me?" look.

Mostly I'm the guy who just sits and watches people. I'm already sick or injured I'll get in when I get in. Getting angry and frustrated is pointless so I try to make the staff smile and thank them, even the cleaning crew. No matter what I do my visit doesn't go any faster or slower. 

I want to thank the emergency room staff in Bend or anywhere people do this work. I understand they can grow numb to the things they witness. To cope with this they seem to all develop a dark humor. 

Keeping a straight face while some poor soul tells that age old story, "I accidentally fell on a cucumber in the garden" or whatever it is they can't retrieve from their rectum. As they dig into the problem I imagine the staff share a private chuckle but on the triage scale it's probably not life threatening, just really uncomfortable. I imagine he will be sitting on that hard plastic chair for just a little longer. 

Another fine example to illustrate the theory of time relativity. Time is relative to which side of the emergency waiting room door you are on.